子宫核分裂活跃型平滑肌瘤的超微结构观察

目的:探讨电镜下子宫核分裂活跃型平滑肌瘤的超微结构特点.方法:选择光镜诊断的7例子宫核分裂活跃型平滑肌瘤的组织标本,在电镜下进行超微结构的观察.结果:瘤细胞大而形态不规则,细胞器丰富,但肌丝、密斑、密体明显减少.细胞核有很深的切迹,核膜凹陷,出现假包涵体.结论:子宫核分裂活跃型平滑肌瘤仍起源于平滑肌细胞,但细胞的合成功能较高,呈一定程度的不成熟分化.     

肾恶性横纹肌样瘤临床病理分析及超微结构观察

目的:探讨肾恶性横纹肌样瘤(MRTK)的临床病理表现及超微结构特点。方法:用光镜、免疫组化及电镜等方法观察其病理组织学特点、免疫组化表达及超微结构。结果:光镜的典型特点是肿瘤细胞弥漫性排列,呈圆形、椭圆形及不规则形,胞质丰富,嗜酸性,部分胞质内可见透明状小体,细胞核圆形或椭圆形,核膜厚,核仁清楚,有的细胞核呈空泡状。部分核偏向一侧似浆细胞样。细胞内外见红染的包涵体。免疫组化显示肿瘤可表达多种抗原。电镜观察特异性表现是胞质内见中间丝及圆形不规则形纤维状或轮状小体。结论:肿瘤细胞弥漫排列呈浆细胞样,免疫组化多方向表达,可向神经性、上皮性、肌性等方向分化。电镜下胞质内中间丝及纤维轮状小体是特异性诊断标志。     

19例子宫平滑肌瘤病理学误诊的原因

子宫平滑肌瘤十分常见,但其病理图像变化甚多,有时也可误诊,现将我室19例原误诊为子宫平滑肌肉瘤的病例作一分析。材料来源我室从1960年至1984年共诊断子宫平滑肌肉瘤40例。经复查,其中19例应诊断为平滑肌瘤。病理与临床资料 19例全部行子宫切除术。大多数肌瘤在肌层中,肌瘤数1～8个,直径3～15 cm,平均7.1 cm。与周围组织界限尚清楚,大部分有假包膜。切面呈编织状或旋涡状,部分切面质地稍细腻。少数有出血坏死。镜下观察:19例中有7例呈典型平滑肌瘤图像,仅偶见个别病理性核分裂或细胞排列稍紊乱。有4例呈现怪细胞型图像。瘤细胞梭形、圆形或不规则多形性。细胞核染     

富含糖原的子宫平滑肌瘤

本文着重讨论富含糖原的子宫平滑肌瘤的临床病理和超微结构特征。富含糖原的子宫肌瘤不同于常见的子宫平滑肌瘤，其光镜下胞质呈空泡状，但在电镜下瘤细胞质内含有大量成堆的糖原颗粒，其原因可能与患者的孕激素水平有关。     

GPR30在子宫平滑肌瘤细胞增殖中的作用研究

目的 探讨跨膜G蛋白偶联受体30(G protein-coupled receptor 30,GPR30)在子宫平滑肌瘤细胞中的表达及其对肌瘤中平滑肌细胞的增殖作用.方法 培养子宫平滑肌瘤原代细胞,应用免疫组织化学、免疫荧光及蛋白质印迹法检测GPR30的表达.应用蛋白印迹检测GPR30干扰后,其下游信号通路的变化.应用MTT检测在雌激素刺激下,正常子宫平滑肌细胞及平滑肌瘤细胞的生长活性.结果 子宫平滑肌瘤细胞中有GPR30蛋白的高表达,其主要位于细胞质中,在细胞核上无明显表达.在未处理组平滑肌细胞中,雌激素刺激雌激素信号通路中的ERK1/2表达增强.在GPR30干扰后的平滑肌细胞中,雌激素刺激后ERK1/2表达无显著改变.MTT结果表明在雌激素作用下,未处理组细胞存活和生长率显著增加;干扰组细胞的存活和生长率显著下降.结论 GPR30在子宫肌瘤平滑肌细胞的细胞质中高表达,可能参与子宫平滑肌细胞的增殖.     

子宫脉管内平滑肌瘤14例

目的 探讨子宫脉管内平滑肌瘤的临床病理特征、治疗及其预后.方法 对自2001年1月至2005年11月间收治并经手术及病理检查证实的14例子宫脉管内平滑肌瘤患者的临床和病理资料进行回顾性分析.结果 临床表现与普通平滑肌瘤类似,术前均诊断为子宫肌瘤,误诊率100%.有7例术中作了冷冻切片检查,其中5例确诊,其余均为术后病理检查确诊.病理检查,肿瘤直径1～9 cm.11例具有典型的子宫脉管内平滑肌瘤的特征,脉管内瘤体表面被覆CD34标记阳性的内皮细胞.全部病例均切除子宫,有3例作了次全子宫切除,11例行子宫全切的病例中有5例同时作了双侧附件切除,4例作了单侧附件切除,另2例只作了单纯全子宫切除.14例中12例随访至今无复发,随访时间7～56个月,平均26个月.结论 子宫脉管内平滑肌瘤是一种子宫平滑肌瘤的特殊类型,具有比较典型的病理学特征及特殊不良生物学行为,但预后良好.     

肺良性转移性平滑肌瘤1例报道及文献复习

目的探讨肺良性转移性平滑肌瘤的临床病理特征,组织发生及鉴别诊断。方法通过光镜、免疫组化染色,对一例肺良性转移性平滑肌瘤的病理学特点进行观察,并进行文献复习。结果巨检：楔形肺组织大小3cm×2cm×1cm,切面暗红,可见一直径0．5cm大小的结节,界清。光镜特点：瘤细胞为长梭形,呈束状、交织状排列,胞浆淡染,胞核梭形、类圆形,两端钝圆,染色质较粗,轻度异型,未见核分裂像。瘤组织与周围组织分界清楚,周边部为单层立方上皮细胞,瘤组织内可见上皮细胞衬里的裂隙,周围可见受挤压的肺泡结构。免疫组化特点-梭形瘤细胞SMA、Desmin、Vimentin、ER（个别细胞）、PR阳性,CK7、CK20、CD31、CD34、HMB45均阴性。结论肺良性转移性平滑肌瘤是一种来源于子宫平滑肌瘤的良性肿瘤,非常罕见,诊断时必须结合病史、影像学检查、病理组织学及免疫组织化学特点才能做出诊断。     

肺平滑肌瘤1例报道及文献复习

目的：探讨肺平滑肌瘤的临床、病理特征及组织起源。方法：对1例肺平滑肌瘤进行光镜及免疫组化观察。结果：无症状女性患者，原有子宫卓滑肌瘤病吏，体检发现双肺多发性结节，镜下示肿瘤主要由梭形细胞构成，编织状、平行状排列，免疫组化示瘸细胞表达ER、PR、SMA。结论：肺平滑肌痼可分为原发与转移，转移者往往有子宫平滑肌瘤病史，但要鉴别原发与转移，需结合光镜、免疫组化基因染色体综合分析。     

Survivin和Caspase-3在子宫平滑肌肿瘤中表达的意义

 目的　探讨Survivin和Caspase-3在子宫平滑肌肿瘤中的表达及其意义,在富于细胞型平滑肌瘤和子宫平滑肌肉瘤的鉴别诊断中的意义。方法　采用免疫组织化学二步法分别检测30例富于细胞型子宫平滑肌瘤细胞、10例正常子宫平滑肌细胞、10例普通型子宫平滑肌瘤细胞、15例子宫平滑肌肉瘤细胞中Survivin和Caspase-3的表达。结果　Survivin在正常子宫肌层组织中仅有个别弱表达,在子宫普通型平滑肌瘤、富于细胞型平滑肌瘤、平滑肌肉瘤中的表达呈上升趋势,且普通型组和肉瘤组差别有统计学意义（P＜0.05）;而Caspase-3在正常子宫肌层、普通型平滑肌瘤、富于细胞型平滑肌瘤、平滑肌肉瘤中的表达呈下降趋势,且正常组与富于细胞型组、正常组与肉瘤组之间差异有统计学意义（P＜0.05）。结论　Survivin可能通过抑制Caspase-3的活性来抑制细胞凋亡,延长细胞寿命,从而在子宫平滑肌肿瘤由良性发展为恶性的过程中发挥重要作用。 二者联合检测有助于子宫平滑肌肿瘤之间的鉴别诊断。     

39例子宫绒毛叶状分割性平滑肌瘤的荟萃分析

目的：总结迄今国内外公开发表的以及我院2000年至2010年诊治的子宫绒毛叶状分割性平滑肌瘤（cotyledonoid dissecting leiomyoma of the uterus）的临床及病理特点。方法：以子宫绒毛叶状分割性平滑肌瘤、子宫绒毛叶状平滑肌瘤、cotyledonoid dissecting leiomyoma of the uterus、cotyledonoid leiomyoma of the uterus、sternberg tumor、grape-like leiomyoma为检索词检索国内外公开发表的文献,并结合我院诊治的3例病例进行荟萃分析。结果：发病年龄为23-73岁,平均年龄43.55岁。缺乏典型的临床症状。大体标本宫壁外部分呈胎盘小叶样,宫壁内部分呈分割性改变,镜下细胞无异型。治疗以手术为主,术后随访1个月至41年不等,无复发病例。结论：子宫绒毛叶状分割性平滑肌瘤虽外观酷似恶性肿瘤,实为特殊类型的良性子宫平滑肌瘤,结合病理特别是术中冰冻病理检查可避免过度治疗。     

The fine structure of astroblastoma

An astroblastoma in the cerebrum was investigated with the electron microscope. A distinctive feature of the tumor was the radial arrangement of astrocytic cells around the blood vessels. The blood vessels in the tumor commonly exhibited fenestrated endothelial cells. The endothelium was generally surrounded by lamellated basal laminae that were compactly invested in the neoplastic cells. The most remarkable feature of the tumor cells was the frequent presence of coated vesicles. The cytoplasm of some tumor cells was filled by delicate glial fibrils and microtubules, whereas that of others contained a moderate amount of rough-surfaced endoplasmic reticulum, free ribosomes, and mitochondria, but only scanty glial fibrils and microtubules. The former usually possessed long, thin cell processes, whereas the latter had poor development of cell processes and commonly showed multiple or giant nuclei containing several nuclear bodies and prominent nucleoli. In summary, this ultrastructural study of astroblastoma revealed the coexistence of varied maturity astrocytic cells and their compact arrangement around fenestrated blood vessels.     

Smooth muscle neoplasms of the uterus other than ordinary leiomyoma. A study of 46 cases, with emphasis on diagnostic criteria and prognostic factors

Thirty-seven cases of uterine leiomyosarcoma are presented, along with nine cases of leiomyoma variants from which they were distinguished. All patients were followed for a minimum of 10 years. In cases with nuclear pleomorphism, leiomyosarcoma was diagnosed when there were five or more mitotic figures in ten consecutive high-power (X400) fields in the most active area of the tumor, and also when there were fewer mitotic figures but extensive tumor necrosis (there was only one leiomyosarcoma without nuclear pleomorphism, and it had more than 20 mitotic figures in ten high-power fields). Tumor size was the major prognostic factor in the leiomyosarcoma group; five of eight patients with neoplasms measuring less than 5 cm in maximum dimension survived, whereas no patient with a larger tumor did so. Other pathologic and clinical variables, including mitotic rate, tumor necrosis, degree of nuclear pleomorphism, vascular invasion, and patient age, had no significant relationship to survival or tumor behavior in leiomyosarcoma when tumor size was taken into account. The nine cases of leiomyoma variants consisted of three atypical leiomyomas (which had nuclear pleomorphism, one or no mitotic figures per ten high-power fields, and no necrosis), two plexiform leiomyomas, two cases of peritoneal leiomyomatosis, one palisaded leiomyoma, and one case of intravenous leiomyomatosis; all of these patients were tumor-free on follow-up.     

Ultrastructural analysis in differential diagnosis of tumors

Ultrastructures of 25 tumors were analyzed by electron microscopy (EM). Of the 25 cases, there were 9 amine precursor uptake and decarboxylation tumors (APUD) (2 carotid body tumor, 2 medullary carcinoma of thyroid and 5 carcinoid) in which the dense core granules of different sizes were seen in the cytoplasm. 4 cases of malignant melanoma were identified by EM basing on the premelanosome and melanosome in the cells. In 4 carcinomas from different locations, 2 had mucous secretory granules in the cytoplasm and junction complex between the tumor cells. The diagnosis was finally confirmed as adenocarcinoma. The other 2 cases were identified as epidermoid carcinoma or anaplastic carcinoma as desmosome and tonofilaments were found. 4 cases of malignant lymphoma without any cell junction complex were identified. Moreover, there were several cases of mesenchymal cell tumors, such as leiomyoma, rhabdomyosarcoma, chordoma and Schwannoma confirmed by their special organelles. This study shows that the ultrastructural analysis is valuable in the differential diagnosis and classification of tumors.     

Ultrastructural changes in atrial myxoma

Ultrastructural changes of 20 cases of atrial myxoma were studied. Under the electron microscope, in a large amount of amorphous matrix, the myxomal cells were either scattered or aggregated. There were numerous microvilli-like cytoplasmic processes on the surface of the tumor cells. In many aspects, the ultrastructural features of the tumor cells were similar to those of the smooth muscle cells. The abundant cytoplasmic filaments were one of the most prominent ultrastructural features. Sometimes, some of them could form dense bodies. There were cytoplasmic filaments in the cytoplasmic processes of a certain tumor cells and lots of micropinocytic vesicles beneath the inner surface of the plasmic membrane. Nuclear membrane of the tumor cells often had marked indentation which was probably related to contraction of the cytoplasmic filaments. 2 of 20 lesions showed malignant characteristics. One lesion infiltrated into the atrial myocardium, and the other involved the left and right atria. It is suggested that the atrial myxoma be a true neoplasm of the atrium with potential malignant tendency. It originates from the multipotential mesenchymal tissue and differentiates mainly towards smooth muscle cells.     

顺铂诱导人结肠癌细胞凋亡的实验研究

 采用细胞培养方法，通过AO染色，DNA微电泳及电镜观察顺铂作用下结肠癌细胞凋亡过程。实验结果表明：结肠癌SW1116细胞在不同浓度的顺铂作用2小时后，呈现不同程度的凋亡。电镜观察到凋亡的细胞表现为细胞核皱缩，核内染色质结块状，趋边缘性分布；DNA微电泳呈拖尾现象，提示凋亡细胞内DNA片断化；凋亡细胞AO染色呈阳性反应，其阳性率随顺铂的浓度增高而递增，与对照组相比，差异有显著意义（P＜0．05）。因此认为顺铂可诱导和促进结肠癌细胞凋亡，这一现象可能是顺铂抗癌作用之一。     

胃粘膜相关淋巴组织淋巴瘤浸润子宫平滑肌瘤病理形态定量研究

目的　对胃粘膜相关淋巴组织( MALT) 淋巴瘤浸润子宫平滑肌瘤病理形态进行定量测定研究。方法　对瘤组织采用常规石蜡切片、HE 染色及ABC 法免疫组化染色, 并运用HPIAS- 1000 彩色病理图文分析系统对肿瘤细胞核的形态进行定量测定。结果　胃粘膜、粘膜下层、肌层及平滑肌瘤内均可见弥漫多量密集成片的中心细胞样瘤细胞浸润, 在胃粘膜内并可见淋巴上皮病变。定量测定的结果表明胃、淋巴结及子宫肌瘤内淋巴瘤细胞细胞核15 项形态参数与对照组间除一项参数外( 胃淋巴瘤细胞与对照组间细胞核的椭圆度) , 所有的指标均有高度显著性差异( P< 0-001) 。结论　MALT 淋巴瘤细胞与正常淋巴细胞形态学参数之间确实具有差异, 定量测定的方法要比用肉眼在光镜下直接观察更为敏感, 其对于MALT 淋巴瘤疑难病例的诊断提供了新的诊断方法, 可能具有十分重要的意义     

On the histogenesis of Ewing's sarcoma. An ultrastructural, immunohistochemical, and cytochemical study

Forty-two cases of Ewing's sarcoma (ES) have been studied with light microscopy during the 9-year period 1974 to 1982. Thirty-three patients had ES of bone, and in 9 patients the tumor was located in the extraskeletal soft tissues. Cases which fulfilled all the morphologic criteria were accepted as typical ES (31 cases), and those with some architectural or cytologic peculiarities were considered atypical forms of ES (11 cases). An immunohistochemical study (PAP method) to evaluate the presence in the tumor cells of the following markers: myoglobin, F-VIII-related antigen, lysozyme, alpha-1-antitrypsin, alpha-1-antichymotrypsin, and immunoglobulins (IgG, IgA, IgM, kappa and lambda light chains), was performed with negative results in all cases (paraffin blocks were available in 38 cases). The cytochemical study on fresh tissue imprints from five patients (PAS, Sudan Black, alpha-naphthyl acetate esterase, acid phosphatase, beta glucuronidase, myeloperoxidases, naphthol-AS-D chloroacetate esterase and alkaline phosphatase) gave no pattern of histogenetic significance, PAS being the best morphologic marker in tissue sections and touch preparations. A detailed ultrastructural study was performed on 34 cases; the main findings may be summarized as follows: medium sized cells, polygonal shape, oval nuclei, smooth nuclear envelope, abundant euchromatin, well-developed nucleolonema, scant membranous organelles, abundant hyaloplasmic glycogen, occasional lipid vacuoles, straight cell membranes, and primitive intercellular junctions. No differences were found between bone and extraskeletal ES; moreover, typical and atypical forms showed moderate quantitative differences with no qualitative change. The histogenesis is discussed; no functional or morphologic markers have been found to suggest the cell of origin; however, some cell lines may be excluded. It is the impression of the authors that they are dealing with a primitive noncommitted mesenchymal cell.     

Tanycytic ependymoma of the filum terminale with pleomorphic giant cells

A tanycytic ependymoma measuring 1.5 cm in maximal dimension, which involved the filum terminale and conus medullaris of a 55-year-old woman, is reported. The tumor consisted of a compact fascicular proliferation of spindle cells having long bipolar cytoplasmic processes, and immunohistochemical and ultrastructural studies demonstrated the ependymal features of neoplastic cells. The most prominent finding was an appearance of many atypical and pleomorphic, often monstrous, giant cells, which was not associated with an increase in proliferative activity. Remarkable nuclear atypism and pleomorphism with formation of giant cells have not been documented previously in tanycytic ependymoma. These nuclear changes are considered essentially degenerative in nature and probably do not portend a worse prognosis despite their worrisome appearance. This tumor could be appropriately termed “giant cell tanycytic ependymoma.”     

Arsenic trioxide induces apoptosis of rat hepatocellular carcinoma cells in vivo

The aim of this work was to study the effect of arsenic trioxide (As2O3) on rat hepatocellular carcinoma (HCC), and investgate on the mechanisms of its antitumor effect. HCC was induced by chemocarcinogen diethylnitrosamine (DEN) in Wistar rats, that were then treated with As2O3 intraperitoneally in three different concentrations once a day for two weeks, and twice a week for another two weeks. The histological and ultrastructural changes in liver tissue were observed under microscope and electronic microscope on the 7th, 14th and 28th day after drug administration. The apoptosis and cellular dynamic parameters of tumor cells were observed by flow cytometry. The expression of bcl-2, bax, and proliferation cell nuclear antigen (PCNA) of rat liver cancer cells on the 7th day after drug administration was determined by using immunohistochemical technique. Treatment with As2O3 caused HCC cells death via both apoptotic and non-apoptotic mechanisms when the dose was high (5 mg.kg(-1)), while necrosis was rare and apoptosis was common when the dose was appropriate (1 mg.kg(-1)). This effect was obviously accompanied with accumulation of cells in G2/M phases (G2/M restriction). Many apoptotic cells were also found in G2/M phases. The expression intensity of bcl-2 or bax varied depending on the dose administrated. Downregulation of bcl-2/bax was observed, accompanied with upregulation of apoptosis. However, the ratio of bcl-2/bax and the percentage of apoptosis were not the utmost when the dose administered was the highest. In conclusion, these data demonstrate that As2O3 induces apoptosis of rat HCC cells, and it is closely associated with G2/M restriction when apoptosis reaches the top. Apoptosis can be observed in all three phases of cell cycle, but it is more common in G2/M phase when the dose is appropriate. It is suggested that arsenic trioxide may be an atypical cell cycle specific agent. Apoptosis of tumor cells is closely associated with down-regulation of the ratio of bcl-2/bax, but that may not be the only dominant factor.